There’s a moment I see again and again when someone tells me they didn’t pass the IBCLC exam.

Their voice softens. They explain how hard they worked. They walk me through everything they studied, often in great detail. And then, almost inevitably, they say something like, “I really thought I knew the material.”

Most of the time, they did.

The issue is rarely intelligence, effort, or commitment. Much more often, it’s something quieter and harder to name: a mismatch between how candidates prepare and what the exam is actually asking them to demonstrate.

When Studying Harder Stops Helping

When an exam feels unpredictable or overwhelming, the instinctive response is to add more effort. More reading. More notes. More resources. More hours. Studying becomes a way to reassure yourself that you’re doing everything possible.

That response makes sense. We are conditioned to believe that effort leads to results, and that if something isn’t working, the solution must be to push harder.

But many candidates walk into the exam having studied extensively and still feel disoriented by the questions in front of them. When that happens, it’s often the first indication that the problem isn’t how much they studied, but how closely their preparation aligned with the way the exam evaluates clinical reasoning.

The Safety of Studying by Topics

Many candidates organize their studying in ways that feel logical and responsible. They work through maternal conditions, infant anatomy, medications, protocols, and physiology as distinct categories. This approach creates structure and a sense of progress. You can see what you’ve covered. You can say, with confidence, that you’ve studied everything.

The problem is that clinical reasoning doesn’t unfold in tidy categories.

The exam rarely asks candidates to recall isolated pieces of information. Instead, it presents situations where multiple factors are interacting at once and asks candidates to decide what matters most in that moment. When studying happens in silos, that kind of integration can feel unfamiliar under pressure.

This is often when candidates leave the exam saying they knew the information but couldn’t tell what the question was really asking them to do.

Why Memorization Feels Reassuring

Memorization offers a sense of certainty. If you can recall a definition, a guideline, or a specific fact, it feels dependable. In a high-stakes situation, that certainty can feel grounding, and many candidates lean into memorization because it provides something solid to hold onto.

But the IBCLC exam does not primarily reward certainty in that way.

It asks candidates to tolerate ambiguity and to choose an appropriate response rather than a perfect one. That shift can be deeply uncomfortable, especially for people who have prepared by anchoring themselves to facts rather than judgment. Knowing a great deal of information does not automatically translate into knowing how to decide between competing priorities.

How Anxiety Changes the Way Questions Are Read

By the time many candidates sit for the exam, they are already carrying an enormous amount of pressure. The exam feels tied to their professional identity, their future, and their sense of competence.

Under that level of stress, the brain doesn’t read neutrally. It scans for threat. It looks for hidden meaning. It second-guesses itself even when no new information has been introduced.

Questions that are meant to assess reasoning can begin to feel deceptive. Straightforward scenarios can feel loaded. Candidates may reread the same question repeatedly, convinced they are missing something important, not because they lack understanding, but because anxiety is distorting how the information is being processed.

When this happens, the experience of the exam can feel far more confusing than the content itself ever was.

When Capability Turns Into Self-Doubt

After an unsuccessful attempt, many candidates don’t question their study strategy. They question themselves.

They assume they weren’t smart enough, disciplined enough, or simply not cut out for this work. They respond by tightening their schedules, adding more materials, and increasing pressure, hoping that doing more will fix what feels broken.

But when the underlying issue is a misalignment between preparation and assessment, more effort alone doesn’t bring clarity. It often deepens frustration. This is where capable clinicians can become stuck, not because they lack ability, but because they haven’t been given the right framework to understand what went wrong.

Before Anything Changes, Something Has to Be Understood

Before deciding what to change, it’s worth pausing to ask a different question.

Was this truly a knowledge problem, or was it a reasoning problem?

Until that distinction is clear, candidates are left guessing. And guessing often leads them back to the same approaches that didn’t work the first time.

Understanding why the exam felt the way it did is often the first step toward approaching it differently.

In the next post, I’ll explore what the IBCLC exam is actually designed to assess and why that clarity changes how candidates think about preparation in the first place.